acs Flashcards
key diagnostic features of ACS
chest pain
dyspnoea
sweating
nausea and vomiting
What is dyspnoea
shortness of breath
chest pain seen in ACS
central or left sided
may radiate to jaw or left arm
described as heavy
1st investigations for ACS
ECG
cardiac markers such as troponin
bloods
What do changes in ECG leads 1 to 4 suggest
abnormality in left anterior descending
what site is used for PCI
radial artery
difference in presentation between unstable angina and an NSTEMI
NSTEMI has elevated troponin
NSTEMI antiplatelet choice
if not taking oral coagulant: prasugrel or ticagrelor
if taking an oral anticoagulant: clopidogrel
when should fondaparinux be given
should be given to all patients with aspirin unless high bleeding risk
in STEMI management when should a PCI be given
if PCI can be given within 2 hours since fibrinolysis could have started
What should be given before a PCI for STEMI
dual antiplatelet therapy: aspirin plus prasugrel or tricagrelor or clopidogrel
What are some of the risks of prasugrel
excess bleeding
What is given instead of prasugrel to reduce side effects and when is it changed
If patient is older than 75 then clopidogrel is given
What happens to D-Dimer during myocardial infarction
it increases
what contraindicates sublingual GTN spray (nitrates)
hypotension
medication of choice for fibrinolysis
alteplase
NSTEMI (managed conservatively) antiplatelet choice
aspirin, plus either:
ticagrelor, if not high bleeding risk
clopidogrel, if high bleeding risk
what happens after STEMI management via fibrinolysis
repeat ECG in 60-90 minutes and transferring for urgent PCI if ST-elevation has not resolved.
